This 2013 narrative review by Sheth, Nelson, and Paprosky outlines a systematic approach to evaluating and managing femoral bone loss in revision THA, covering preoperative workup, classification systems, and reconstruction options matched to defect severity.
When planning a femoral revision, classify bone loss by Paprosky type first — it directly determines your implant: porous-coated stem for types I–IIIA, modular tapered fluted stem for IIIB (especially if canal >19 mm), and structural reconstruction (APC or impaction grafting) for type IV. Recognize that extensively porous-coated stems lose reliability once the isthmus drops below 4 cm or the canal exceeds 19 mm — pushing into those zones with the wrong implant triples your failure rate.
This 2013 narrative review by Sheth, Nelson, and Paprosky outlines a systematic approach to evaluating and managing femoral bone loss in revision THA, covering preoperative workup, classification systems, and reconstruction options matched to defect severity.
When planning a femoral revision, classify bone loss by Paprosky type first — it directly determines your implant: porous-coated stem for types I–IIIA, modular tapered fluted stem for IIIB (especially if canal >19 mm), and structural reconstruction (APC or impaction grafting) for type IV. Recognize that extensively porous-coated stems lose reliability once the isthmus drops below 4 cm or the canal exceeds 19 mm — pushing into those zones with the wrong implant triples your failure rate.